Care Management Analyst, Clk Street Medicine - Clearlake

Job Description Located in beautiful Northern California Adventist Health Clear Lake has been a leading healthcare provider in Lake County since 1968 We are comprised of a 25-bed critical access hospital and provide primary and specialty care services at clinics throughout the area to best serve our community This area is perfect for outdoor enthusiasts with some of the best bass fishing rural trails for hiking and biking all while being only two hours from the San Francisco Bay Area Sacramento Valley or Pacific Coast Job Summary Reviews patient encounters and medical records to determine if improvement opportunities exist through either technological or communication enhancements Supports the execution of system-wide strategic initiatives process re-design root cause analysis metric/report development as it relates to clinical reviews and denial management Analyzes monitors reports findings and provides recommendations on key report sets to Adventist Health leadership and utilization management committee Works closely with key departments e.g. on-site care management medical staff HIM/coding patient financial services etc. to review obtain the medical documentation required to streamline the adjudication process Tailors communications to respective audiences e.g. system leaders versus regional leaders ensuring that specific mitigation action plans are created implemented Supports facilitates design implementation of utilization management data collection reporting methodologies Develops analytic models trending displays dashboards inform executive leaders oversight committees Key stakeholder process outcomes high priority metrics functions opportunities improvement progress goals Understands utilization management impact claim adjudication

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